Anthropometry in pediatrics

1. ANTHROPOMETRY
DR.HAFSA
DNB PEDIATRICS

2. REFERENCES
• “Kleigman, Behrman, Jenson, Stanton, Nelson textbook of pediatrics”;21st edition
• “Vinod K. Paul, Arvind Bagga, Ghai Essential Pediatrics”,9th edition
• “Aruchamy Lakshmanaswamy, Clinical Pediatrics history taking and case
discussion”

3. ETYMOLOGY
• Anthropo = human ; metron = measure
DEFINITION
• Study of measurement of the human body in terms of
dimensions of bone, muscle and adipose tissue

4. IMPORTANCE
1. Key component of nutrition status assessment
2. Reflects general health status and dietary adequacy
3. Used to track trends in growth and development over
time

5. WEIGHT
INSTRUMENTS
• 1. Beam scale
• 2.Digital weight scale
• 3.Spring machine
• 4.Portable scale

7. MEASUREMENT OF WEIGHT
• NEONATES :
• Placed on scale with all clothes and diapers removed
• SMALL CHILDREN
• With the assistance of an adult
• OLDER CHILDREN
• Asked to remove shoes and stand on scale

9. BIRTH WEIGHT
• Normal- 2.5 to 3.5 kg
• Low birth weight <2.5kg
• Very low birth weight <1.5kg
• Extreme low birth weight <1kg

10. WEIGHT GAIN
AGE WEIGHT GAIN
10 days – 3 months 30 g/day
3 -6 months 20 g/day
6 -9 months 15 g/day
9-12 months 12 g/day
1-3 yrs 3 kg/yr
4-12yrs 2 kg/yr
>12yrs 5-6 kg/yr

11. EXPECTED WEIGHT
• 3 to 12 months = Age (months) + 9
2
1 to 6 yrs = Age (years) * 2+8
7 to 12 yrs = Age in (years)* 7- 5
2

13. WEIGHT VELOCITY
AGE WEIGHT
5 MONTHS 2* BIRTH WT
1Yr 3*
2Yr 4*
3Yr 5*
5Yr 6*

14. RECUMBENT LENGTH
• INFANTOMETER (fixed head piece ; adjustable foot piece)
• <2yrs

15. STANDING HEIGHT
• STADIOMETER
• Children > 2yrs

17. EXPECTED HEIGHT
AGE LENGTH/ HEIGHT
Newborn 50cm
1yr 75cm
2yr 87 to 90 cm
3yr
4yr
95cm
100cm

18. WEECHS FORMULA
• To calculate expected height from 2 to 12 yrs
• (Age in yrs * 6) + 77

19. GAIN IN HEIGHT
AGE RATE OF INCREASE IN STATURE
Birth to 3 months 3.5 cm/month
3-6 months 2 cm/month
6-9 months 1.5 cm/month
9-12months 1.3 cm/month
2-5 yrs 6 - 8 cm/yr
5-12 yrs 5 cm/yr

20. MID PARENTAL HEIGHT
• MPH for boys = Father’s height (cm) + Mothers height(cm) + 13
2
• MPH for girls = Mothers height (cm) + Fathers height (cm) – 13
2
• Projected adult height is MPH +/- 8.5cm

21. HEAD CIRCUMFERENCE
• Rate of increase of H.C is more in 1st yr of life
• Measurement is with tape ;
over occipital protruberance at the back
over supraorbital ridge and glabella in front

22. EXPECTED H.C
AGE H.C (cm)
At birth 34 - 35
2 months 38
3 months 40
4 months 41
6 months 42 - 43
1 year 45 - 46
2 years 47 - 48
5 years 50 - 51

23. GAIN IN H.C (0 – 5 YEARS)
AGE GROWTH VELOCITY OF H.C
0-3 MONTHS 2 cm/month
3-6 MONTHS 1cm/month
7-12 MONTHS 0.5 cm/month
1-3 YEARS 1 cm/6 months
3-5 YEARS 1 cm/year

24. CHEST CIRCUMFERENCE
• Measured at the level of nipples in mid inspiration
• At birth HC > CC by 3cm
• At 1 year HC = CC
• After 1 year CC > HC

25. UPPER SEGMENT/ LOWER SEGMENT RATIO
• Upper segment = Length b/w vertex and pubic symphysis
• Lower segment = Length b/w pubic symphysis and heel
• This ratio is decreased in rickets

26. AGE US / LS RATIO
At birth 1.7 : 1
6 months 1.6 : 1
1 year 1.5 : 1
2 years 1.4 : 1
3 years 1.3 : 1
4 years 1.2 : 1
7 years 1.1 : 1
10 years 1 : 1

27. ARM SPAN
• Distance b/w tips of middle fingers of both arms when they are
outstretched at right angles to the body.
• Less than 5 years of age = AS < Height by 1-2 cm
• 10 – 12 years of age = AS = Height
• There after AS > Height (Difference always less than 3cm)

28. CONDITION WITH AS > HEIGHT
• Marfan’s Syndrome
• Klinfelter’s syndrome
• Homocystinuria
CONDITION WITH AS < HEIGHT
• Acrondoplasia
• Cretinism

29. MID ARM CIRCUMFERENCE
• Measured with a non-stretchable tape mid way b/w Acromion and Olecranon
process while the child holds left arm by his side
• At birth 9-11cm
• 1 – 5 years = 16- 17 cm
• BANGLE TEST : done with fibre glass ring of internal diameter 4cm.
If it passes above elbow MAC <12.5cm child is malnourished

31. • SHAKIR TAPE:
Fibre glass tape with different colour coding
colour MAC(cm) Grade of
malnutrition
Intervention
required
RED <12.5 Severe Admit and treat
YELLOW 12.5 – 13.5 Moderate Dietary advice
GREEN >13.5 Normal No intervention

32. SKINFOLD THICKNESS
• Measured with Harpenden’s callipers
• Areas- Triceps, Biceps, Subscapular, Suprailiac
• 1-6 yrs; >10 mm = normal
<6mm = abnormal

33. MALNUTRITION
• WASTING
Weight for height < 2 S.D of WHO child growth standard median
• STUNTING
Height for age < 2 S.D of WHO child growth standard median
WEIGHT FOR HEIGHT
Weight of the child (kg) / weight of normal child of same height (cm)* 100

34. CLASSIFICATIONS
• WELCOME TRUST CLASSIFICATION

35. IAP CLASSIFICATION

36. BMI

37. UDANI CLASSIFICATION

38. Ponderal / Corpulence / Rohrer index
=weight (g) /height (cm)3 * 100
normal: > 2.5
borderline malnutrition: 2 - 2.5
severe malnutrition: < 2
In Neonates
terms (appropriate for gestational age): > 2.5
asymmetric IUGR: <2
symmetric IUGR : >2

39. Quetelet index
= weight (kg)/height2 (cm)*100
normal:0.14-0.16
malnutrition: <0.14
Body mass index
= weight (kg)/ height2 (m)
Dugdale’s index
= weight(kg)/ height^1.6*100
Normal : 0.88-0.97
Malnutrition : <0.79

40. Kanawati and Mclaren index (for 3 months to 4yrs age)
= mid arm circumference(cm) / head circumference(cm)
normal: >0.32
mild malnutrition: 0.28-0.32
moderate malnutrition: 0.25-0.28
severe malnutrition: <0.25

41. THANK YOU